Does poor communication contribute to stillbirths and infant deaths? A review

Background Assessors from the Confidential Enquiry into Stillbirths and Dea ths in Infancy (CESDI) have cited poor communication as a contributory fact or in a proportion of such deaths. This review assesses what research evide nce exists to support or explain this. Methods A structured review was carried out, including all studies of sub-o ptimal care in stillbirth or infant death and studies of litigation in peri natal care. The following databases were searched: MEDLINE, PsycLIT, The Co chrane Library, BIDS Science and Social Science Citation Indexes, Cinahl an d Embase. For included studies, information was extracted on the type of st udy, the selection criteria and number of cases studied, other methods used and results relevant to the question. Results One hundred and four studies of potential relevance to the review w ere identified. Of these, 52 did not meet the inclusion criteria and were e xcluded. Of the remaining 52 studies, 11 considered communication failure e xplicitly as a factor in sub-optimal care leading to stillbirth or infant d eath. In three out of the four studies that presented their findings in ter ms of numbers of cases, communication failure was noted in between 24 and 2 9 per cent of cases. There was some consistency across different types of s tudy in the types of communication problems noted. Conclusion Poor communication may contribute to a proportion of stillbirths and infant deaths. However, given the small number of papers that looked e xplicitly at poor communication as a factor in sub-optimal care and the lac k of comparative information on communication in cases that do not end in p oor outcome, caution is needed in drawing conclusions based on the findings of these papers.